Ectopic pregnancy means pregnancy, in which implantation occurred outside the uterus - usually in the fallopian tube (99% of cases).

Ectopic pregnancy is found in 1-4% of the total number of gynecological patients. The most common cause of ectopic pregnancy are inflammatory changes in fallopian tubes.

In addition, a large role is played by infantilism and various endocrine disorders, altering intestinal tubes. Chorionic hairs germinate to the whole thickness of the uterine tube deeply, not meeting the exposure of proteoclastic enzyme decidua on its route, as it is weak in a tube. Ectopic pregnancy may be terminated either with a tubal abortion, when a fetal egg is pushed through ampullar end of the pipe, or pipe breakage, due to its germination with chorion hairs. In both cases there is intraperitoneal bleeding, which results in formation of blood accumulation in the tube, or retrouterine hematoma. When pipe break, bleeding is particularly strong.

Signs of ectopic pregnancy

There are progressive and terminated ectopic pregnancies. Progressive ectopic pregnancy is accompanied by the same symptoms as uterine (missed period, nausea and vomiting in the mornings, cyanosis of the vagina and cervix, softening and increase of uterus and others). Usually, ectopic pregnancy is not diagnosed at this stage of development and taken for uterine. Changes in the uterine tube are expressed slightly in ectopic pregnancy.

Termination of ectopic pregnancy as a result of tube rupture usually occurs at 6 to 8 weeks. Suddenly, there are sharp abdominal pain with irradiation up (frenikus-symptom), or down in the area of external genitalia, or rectum, dizziness, fainting, decreased blood pressure, increased heart rate and increasing signs of internal bleeding. Such a feature, as bloody discharge from genital tract may be absent, as the decidua has no time to exfoliate from uterine walls.

Tubal abortion disorder can occur for a long time and have a diverse picture. Usually, on the background of a small menstruation delay while ectopic pregnancy, patients have cramping abdominal pain, a feeling of general weakness, dizziness, nausea. After a few days, there appears a dark bloody discharge from genital tract. These symptoms are intermittent while ectopic pregnancy. Body temperature is normal or low-grade (less likely). While significant internal bleeding, symptoms are similar to those in the pipe rupture. Correct diagnosis of progressive ectopic pregnancy is rarely determined. The diagnosis of ectopic pregnancy is set basing on the data history (salpingoophoritis, infantilism, hormonal disorders), a characteristic menstruation delay, clinical picture and other features.

When uterine tube rupture, clinical picture of the disease is determined by pain syndrome, internal bleeding and increasing anemia. Palpation of the abdomen is painful, especially in the lower divisions, on the side of pathologically altered pipes location. There are peritoneal symptoms. When significant bleeding, they reveal blunting of a percussion sound in the lateral abdomen. When moving a patient from side to side, boundaries respectively move. When vaginal study, they note signs of mucous membranes cyanosis, a slight increase in uterine size (it is less than it should be on the probable date of pregnancy), its softening. Palpation of the uterus on the affected side causes sharp pain and defensive reaction of abdominal muscles, and palpation of increased appendages often fails. Posterior vaginal vault bcomes painful while palpation. If posterior vaginal vault is punctured, there is dark blood with small clots (not always). Ectopic impaired pregnancy, which flows by type of tubal abortion, requires a long time for recognition, since similar features are observed in other diseases: starting uterine abortion, inflammation of the uterus, acute appendicitis, etc. Therefore, for ectopic pregnancy diagnosis, in addition to the above-described signs, additional tests also gain value (biological or immunological reaction to pregnancy, vaginal vault rear puncture, laparoscopy, ultrasound study, etc.).

Ectopic pregnancy treatment

If ectopic pregnancy is suspected, a patient is urgently hospitalized. Once the diagnosis is set, there should follow an urgent operation with simultaneous application of anemia and shock remedies (if any). After the surgery, doctors perform rehabilitation treatment, which is the prevention of repeated ectopic pregnancy (5%), and treatment of uterine opposite side appendages inflammation: they prescribe hydrotubation sessions in conjunction with ultrasound.